1. Medical Leadership Influencing Culture and Patient Safety
DR JOHN SIMPSON
Associate, CLINICAL LEADERSHIP SOLUTIONS
Senior Professional Officer, RQIA, N. IRELAND
Formerly Medical Director, SHSCT, N. IRELAND

2. OVERVIEW
Positive culture, positive outcomes Negative culture, negative outcomes
Useful tools and background reading
Linking medical leadership/engagement with patient safety/positive culture change
Medical leadership/patient safety system: learning applicable locally and nationally?

3. WHY? 1. NEGATIVE CULTURE, NEGATIVE OUTCOMES
Learning from Bristol: Response to the Public Inquiry into children’s heart surgery at Bristol London: DoH (2002)
Mid Staffs NHS Trust Public Inquiry Francis (2013)
“Place quality of care, especially patient safety, above all other aims.” Berwick (2103) A promise to learn – a commitment to act. London: Department of Health
Medical leadership: why it’s important, what is required and how we develop it Warren (2011) Postgrad Med J

4. WHY? 2. NOT ONLY MEDICAL LEADERSHIP….
“distributive leadership” (However I think medics must make the first move.) Kings Fund (2012) Leadership and Engagement for Improvement in the NHS, Together we can.
“collective leadership development rather than just developing leaders” West et al (2015) Leadership and Leadership Development in Health Care. Kings Fund, FMLM, Centre For Creative Leadership
“You cannot assume safety, only improve it.” Leonard (2012) How can leaders influence a safety culture? The Health Foundation

5. Medical Engagement Definition
HOW? 3. USEFUL TOOLS
Medical Engagement Definition
“The active and positive contribution of doctors, within their normal working roles, to maintaining and enhancing the performance of the organisation, which itself recognises this commitment in supporting and encouraging high quality care.”
Spurgeon et al (2015), Medical Engagement and Improving Quality of Care, Future Hospital Journal, FMLM
MEDICAL ENGAGEMENT SCALE ( Spurgeon et al) – ranges from excluded to embedded and correlates to performance measures of quality, patient led criteria and financial measures as per CQC England

6. HOW? 2. USEFUL TOOLS
Framework for Appraisal/Revalidation, GMC Good Medical Practice (2011) Linking appraisal to meaningful participation in patient safety APPRAISAL DISCUSSION: evidence, reflection, learning, action points, review
Medical Leadership Competency Framework (2010), Academy of Medical Royal Colleges, NHS Institute for Innovation/Improvement Applicable to all consultant appointments?
Maintaining High Professional Standards, (2003) DoH, London Managing disruptive and unprofessional behaviour

7. HOW? 3. USEFUL TOOLS
An organisation with a memory – Report on learning from adverse events in the NHS Donaldson (2000) Dept of Health, London
Manchester Patient Safety Framework National Patient Safety Agency (2006)
Patient-Safety-Related Hospital Deaths in England: Thematic Analysis of a National Database, Donaldson et al (2014) PLOS Medicine June 2014, vol 11
Does Improving Quality of Care Save Money? Ovretveit (2009) BMJ

8. Implementation Southern Health and Social Care Trust (2011 – 2015)
All Secondary healthcare/social care 350,000 popn DGH’s and Community Care (Budget £500m)
200 consultants, 100 SAS doctors, trainees and Out of Hours GP’s (job plans include sessions for QI/ CPD)
MD, 10 AMD’s, 20 CD’s, Lead Clinicians, Medical Education Leads, Chairs of patient safety fora, Lead Clinicians (Cost £1.2m)

9. 1. REFRAMING MEDICAL LEADERSHIP
Clarifying Purpose
Restructuring – Strengths and Weaknesses
Recruitment and Development
Appraisal
Performance Management

10. 2. INVOLVING PATIENTS AND CARERS
Facilitate and Align with Patient/Carer Bodies
Provide Training and Support
Recruit Two People for Each Key Committee
Link with Board Non – Executives

11. 3. BUILDING A PATIENT SAFETY SYSTEM
PATIENT OUTCOME FOCUSSED
BUILD ON WHAT EXISTS
MULTI
DISCIPLINARY
ACROSS ALL SPECIALTIES
LINK TO COMPLAINTS & LITIGATION
BENCHMARK LOCAL, NATIONAL LEARNING
OUTPUTS AND FEEDBACK
OVERSIGHT – MD, BOARD, PATIENTS AND CARERS

12. Questions and Answers Are these useful tools? Cost?
Transferable learning from N.Ireland/UK?
Are these useful tools?
Linking medical appraisal with patient safety, applicable to you?
Questions and Answers
Medical leadership/patient safety models, applicable to you?
Cost?
Investment in medical time/harm reduction